E-health, as it is known, earned a single sentence in the 30-page COAG communique released on Tuesday, with state and federal governments saying they "noted the importance of continuing to work towards" a national electronic health record system, and had "agreed to prioritise discussions" on the issue.
But IT advocate and GP Mukesh Haikerwal -- one of the 10 members of the National Health and Hospitals Reform Commission, whose final report formed the basis for the reform plans -- said inadequate computer systems, software or differences in data-gathering practices meant many of the measures would face serious delays.
Under the plans, major hospitals will be paid on the basis of the efficient price for the services they provide, which requires health services to collect accurate data on what conditions they have treated and what it cost to treat them.
"The biggest gaping hole is how are you going to measure this stuff?" Dr Haikerwal said.
"Benchmarking indicators, turnaround times, pay-for-performance -- how are you going to measure that without a mechanism to do it?
"The systems we have today are 1970s technology, and the parameters used have been dreamed up in a bathtub and have no bearing on reality."
As an example, he said there was great focus on measuring the waiting times in emergency departments or for elective surgery, whereas a more meaningful measure would be the time a patient had waited since first being diagnosed, or first seeing their GP for the problem. "If you do a hip replacement on a patient, how are you going to measure what it cost (the hospital)?" Dr Haikerwal said yesterday.
"If the person is older or has complex problems, or stays longer, it will cost more, but how are you going to measure that?
"How are you going to know when they have been discharged from intensive care back to the ward, from the ward to step-down care, and how will you know they have gone to the GP and not been lost to care?"
He said better records were "fundamental to drag us out of the dark ages . . . (otherwise) the big potential will be squandered and you will have people walking around with clipboards."
Dr Haikerwal said it had been estimated that an injection of $1.6 billion would be enough to kick-start the necessary improvements, which could start to flow through within 18 months once unique patient identifier numbers were created later this year.
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Autor(en)/Author(s): Adam Cresswell
Quelle/Source: The Australian, 22.04.2010
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